Grant: Travel Awards - Institute Community Support

Obstructive sleep apnea (OSA) is sleep-related breathing disorder characterized by repeated airway obstruction during sleep in association with sleep fragmentation and intermittent hypoxemia. OSA may cause daytime sleepiness, traffic accidents, and predispose to health problems such as hypertension or stroke. Continuous positive airway pressure (CPAP) is recommended treatment for OSA. However, CPAP treatment acceptance is low. Understanding critical elements associated with a patient's decision to purchase CPAP, such as an income status, is crucial in promoting treatment acceptance. Ontario has a universal health system that covers diagnosis of OSA and 75% of the CPAP cost regardless of patient income. Patients usually co-pay from $200 to $400 depending on the supplementary health insurance and CPAP type. This offers a unique environment to evaluate if patient income status limits purchase/acceptance of CPAP. To do so, we linked information on 4,291 patients with OSA to the provincial health administrative data to determine who purchased CPAP and patients' income status. We focused on patients with severe OSA assuming all these patients purchase the device. In patients with severe OSA the percentage of subjects with the lowest income was higher among those who did not purchase CPAP. However, controlling for age, sex, body mass index, smoking status, and comorbidities, there was no significant relationship between income level and CPAP purchase. Our finding suggests that in the province of Ontario, financial concerns may be not an obstacle to CPAP treatment for this patient population. However, even among patients with severe OSA the CPAP acceptance rate was low at 58%. Our findings may support decision making about co-payment amount for policy makers. An increase in amount of co-payment may result in further dropping in acceptance. From the physician perspective, CPAP acceptance level may be improved by providing early education and support for patients.